Renal Colic Patients Research Articles

A study of CT in the renal colic patients at tertiary health care centre

A study of CT in the renal colic patients at tertiary health care centre

Comparison of intramuscular injection of ketorolac and conventional treatment in the field of cost-effectiveness, length of stay and pain relief in patients admitted to the emergency department with renal colic

Background: Pain resulting from the stone passage is one of the most severe and intractable pain experiences. The aim of our study is evaluating the effect of intra-muscular ketorolac on pain reduction; reduce the length of stay and cost of patients with renal colic.Methods: This was a randomized clinical trial study which held in an academic emergency department (ED). Based on defined criteria, 222 patients with renal colic were randomized in two groups: half of them received a single intramuscular injection of 30 mg ketorolac, and other 111 patients got conventional treatment (hydration, morphine sulfate). Demographic characteristics, pain score after 30 minutes, the length of stay in ED, complications as well as hospital costs were recorded for both groups.Result: The baseline characteristics and pain score were similar in the two groups (p>0.05). Ketorolac was significantly (p<0.001) more effective than conventional treatment in reducing pain score. Those treated with ketorolac left the ED significantly earlier than those treated with conventional treatment (65.54; 95%CI, 59.7-71.5 vs. 193.1; 95%CI, 172.8-215.2 minutes, p<0.001). Drug adverse effects (nausea, dizziness, and drowsiness) and cost of ketorolac group were significantly lower than the control group (43310 Tomans (110$) (95% CI, 42590-44030) vs. 150410 Tomans (350$) (95% CI, 240100-70940). (p<0.001).Conclusion: This study showed that intramuscular ketorolac as a single agent for renal colic is cost-effective and promotes earlier discharge of renal colic patients from the ED.

Comparison the analgesic effect of magnesium sulphate and Ketorolac in the treatment of renal colic patients: Double-blind clinical trial study

BackgroundUreter muscles contraction movements caused pain in renal colic. Magnesium sulphate could influence the pain by reducing acetylcholine in the nerve terminals. We have aimed to evaluate the analgesic effects of magnesium sulphate on acute renal colic pain. MethodIn this double-blind clinical trial study, the patients with renal colic pain were randomly divided into 2 groups; Group I received an intravenous infusion of 30 mg of Ketorolac and normal saline as placebo, Group II 50 mg/kg magnesium sulphate 50%/100 ml normal plus 30 mg of Ketorolac. The pain severity of patients was assessed using the visual analog scale (VAS) at baseline, and 15 and 30 min after intervention. ResultsBaseline pain score and demographic characteristics did not significantly different between the groups. After 30 min the pain score significantly reduced in both groups. While, at 15 and 30 min, mean pain score did not show statistically significant differences. ConclusionOur findings indicated that Magnesium sulphate did not influence renal colic pain relief.

Does co-treatment with ultra-low-dose naloxone and morphine provide better analgesia in renal colic patients?

ObjectiveThis study attempted to evaluate the efficacy of ultra-low-dose intravenous (IV) naloxone combined with IV morphine, as compared to IV morphine alone, in terms of reducing pain and morphine-induced side effects in patients with renal colic. MethodsIn this double-blind clinical trial, 150 patients aged 34 to 60 years old who presented to the emergency department (ED) with renal colic were randomly allocated to either an intervention group that received ultra-low-dose IV naloxone combined with IV morphine or to a control group that received morphine plus a placebo. The severity of pain, sedation, and nausea were assessed and recorded for all patients at entrance to the ED (T1), then at 20 (T2), 40 (T3), 60 (T4), 120 (T5), and 180 (T6) minutes after starting treatment. The Numeric Rating Scale (NRS) was used for the assessment of pain and nausea intensities, and the Ramsay Sedation Scale (RSS) was used to assess sedation. ResultsA GEE model revealed that patients in the naloxone group had non-significantly reduced pain scores compared to those in the morphine group (coefficient = −0.68; 95% CI: −1.24 to −0.11, Wald X2 (1) = 5.41, p = 0.02). The sedation outcome demonstrated no statistically significant differences at T1 to T4 among patients with renal colic compared to the ones who only received morphine. At T5 and T6, 1.5% vs. 20% and 1.5% vs. 16.9% of subjects from the naloxone group versus the morphine group obtained RSS scores equal to 3, respectively (p = 0.001 and p = 0.004, respectively). ConclusionsCompared to patients who only received IV morphine, co-treatment of ultra-low-dose naloxone with morphine could not provide better analgesia and sedation/agitation states in renal colic patients.

Intranasal ketorolac and opioid in treatment of acute renal colic

The usual treatment of pain in acute renal colic is analgesic in intravenous (IV) route. We tried a rapid, non-painful, non-invasive route of administration using intranasal ketorolac plus fentanyl versus IV standard treatment with non steroidal anti-inflammatory drug plus opioid for the relief of pain in renal colic presenting patients to an Emergency Department (ED). We conducted a prospective nonblinded clinical trial. A sample of 82 adult patients with clinical diagnosis of acute renal colic was included to receive either intravenous ketorolac plus fentanyl or intranasal ketorolac plus fentanyl. Pain score was rated by using a 10 cm visual analogue scale at 0, 30 and 60 minutes after the treatment. Primary outcome was pain reduction. Secondary outcomes were adverse events and rescue treatment. Eighty-two patients were enrolled. The first forty-one patients received intranasal ketorolac plus fentanyl and the second forty-one received intravenous ketorolac plus fentanyl. There were not statistically significant differences in reduction of pain between the two groups at 30 and 60 minutes (P-value at 30=0,225; P-value at 60=0,312) although the trend was in favour of IV group. There were no significant differences between the groups with regard to secondary outcomes (adverse events and rescue treatment). Intranasal ketorolac and fentanyl are equivalent in analgesic effect to intravenous ketorolac and fentanyl treatment for ED patients with acute renal colic and the intranasal treatment can be considered a valid alternative to the standard intravenous treatment.

LO20: Emergency department initiated drug therapy and patient compliance in acute renal colic

Introduction: NSAIDS offer more effective analgesia than opioids, require less rescue medication, and decrease the incidence of nausea and vomiting in renal colic patients. Alpha blockers and Opioids are also prescribed frequently, but doses used and treatment durations are not well described. Our objective was to investigate ED prescribing decisions and medication compliance by patients with acute renal colic. Methods: In this prospective two-city cohort study, we invited patients with a first ED visit for image-confirmed 2-10 mm ureteric stones to consent to a telephone survey 10 days after their ED visit. During follow-up interviews, patients were asked what drugs they were prescribed and how many doses they required. This study was REB approved. Results: A convenience sample of 224 patients, including 152 males (67.9%) and 72 females (median age= 52.4 years) completed 10-day surveys. NSAIDS were prescribed for 48.7%, tamsulosin for 65.2% and opioids for 81.7%. One-third received a tamsulosin-NSAID combination, 40% an opioid-NSAID combination and 28% a tamsulosin-NSAID-opioid combination. Of 109 patients prescribed an NSAID, only 70 (64.2%) took 1 dose/day; however an additional 28 who were not prescribed NSAIDs took 1 NSAID dose/day. Mean (sd) NSAID intake in the overall study group was 1.1 (1.5) doses/day from day 1-5 and 0.6 (1.1) doses/day on days 6-10, with 90%ile values of 3.0 and 2.0 doses/day. NSAID compliance was more common in patients who stated they received high quality discharge instructions (63.8% vs. 32.6%; RR=1.95; 95% CI 1.47-2.60). Mean opioid intake in the overall study group was 1.2 (1.7) doses/day from day 1-5 and 0.5 (1.3) doses/day on days 6-10, with 90%ile values of 4.0 and 2.0 doses/day. Among patients prescribed tamsulosin, the average was 4.0 days of compliance (sd=4.3), with a 90%ile value of 10 days. Conclusion: This study provides estimates for the amount of drug actually used by renal colic patients during the 10-days after their ED visit. Patients used fewer opioid doses than expected, and NSAID and tamsulosin compliance appears relatively poor. NSAID compliance was better in patients who perceived high quality discharge instructions. This study suggests there is room for improvement in medication prescribing and discharge instructions for ED patients with an acute episode of ureteral colic.

Osmangazi University score to reduce ionizing radiation in renal colic patients in emergency department

Objective:Computerized tomography remains the gold standard imaging in renal colic patients. In this study, we develop a scoring system to select patients in emergency department for unnecessary computerized tomography imaging in order to decrease radiation exposure.Methods:Computerized tomography imaging of patients with renal colic in emergency department were retrospectively reviewed. Symptoms, laboratory results were recorded. Significant parameters were determined by univariate and multivariate analysis. Coefficients were found to obtain score points and receiver operating curve was used to find a cut-off value.Results:A total of 123 patients with a mean age of 42 years (18–75 years) were enrolled in the study. About, 20.3% of patients were stone-free in computerized tomography. Mean stone size was 6.1 ± 1.89 mm. According to analysis, four parameters were significant; nausea, stone history, creatinine, and hematuria with a total score 9 called as Osmangazi University STONE score. Cut-off value was found as >3, which computerized tomography imaging is recommended.Conclusion:Osmangazi University STONE score is useful and simple tool in emergency department to reduce unnecessary computerized tomography imaging in renal colic patients and also lowers cost and ionizing radiation exposure.

Inter-observer Agreement between Urologists and Radiologists in Interpreting the Computed Tomography Images of Emergency Patients with Renal Colic.

Low-dose non-enhanced computed tomography (LDCT) has been shown to provide low radiation exposure with proper diagnostic accuracy compared to standard dose non-enhanced computed tomography (SDCT) in patients with renal colic. The goal of our study is to estimate the accuracy of LDCT and SDCT interpretation by emergency medicine residents who primarily treated patients with renal colic. Thirty sample images of both LDCT and SDCT from renal colic patients were extracted from January 2013 to December 2015 in a tertiary teaching hospital. Five emergency medicine residents interpreted60 image samples over a time span of 3 weeks. The presence of a ureteric stone, the stone's size and location, and signs of obstruction were recorded in the reports. A total of 300 reports were compared with formal readingsby a radiologist. The inter-observer agreement and kappa value were calculated for comparative analysis. Identification of ureteric stones showed almost perfect inter-observer agreement on SDCT (kappa value: 0.93), and the percentage of agreement was 96.7%. However, on LDCT, the inter-observer agreement was substantial (kappa value: 0.73), and the percentage of agreement was 88.0%. Using SDCT, emergency medicine residents had almost perfect inter-observer agreement in interpreting the CT images of patients with renal colic compared to a radiologist. However, when using LDCT, they had a lower inter-observer agreement.

An observational study of incidence of urological intervention in patients of renal colic with normal and abnormal ultrasound study

Background: Renal colic is a common presentation that affects millions people annually. Although ultrasonography has lower sensitivity and specificity in diagnosing urolithiasis compared to CT, it is an alternative imaging modality that does not expose the patient to ionizing radiation. By this observational study an attempt has been made to know the incidence of urological intervention in suspected renal colic patients with normal USG findings, so as to decreasing the number of CT scans and associated ionizing radiation in patients with suspected renal colic.Methods: This was an observational study involving adult patients presenting to the Trauma and Emergency Care Department in Shree Krishna Hospital with suspected renal colic over a 12-months period. Renal ultrasonography was performed in suspected renal colic patients, and the results were categorized into three mutually exclusive groups: normal, suggestive of ureterolithiasis, or visualized ureteric stone. Patients were followed up to see if patients received urological intervention.Results: Of 132 patients enrolled, 16 (12.12%) were classified as normal; none of these patients underwent urologic intervention. 62 (46.92%) USG results were classified as suggestive of ureterolithiasis, and one (1.61%) patient received urologic intervention. A total of 54 (40.91%) USG results were classified as visualized ureteric stone, and 24 (44.45%) patients had urologic intervention. The rate of urologic intervention was significantly lower in those with normal USG results (p <0.001) than in those with abnormal findings.Conclusions: A normal renal ultrasonography predicts a low likelihood for urologic intervention for adult patients with suspected renal colic.

The effect of nitrous oxide in comparison to oxygen combined with fentanyl on the hospitalization time and pain reduction in renal colic patients at emergency department.

Background:Renal colic is a painful medical emergency, needs urgent intervention to reduce pain. Nonsteroidal anti-inflammatory drugs, opioids, and entonox are pain-relieving agents. This study was aimed to compare fentanyl + entonox (nitrous oxide + O2) versus fentanyl + oxygen.Materials and Methods:One hundred and twenty patients with acute renal colic presenting to the emergency department were enrolled. First, 50 μg fentanyl was infused for all patients. Then, patients divided into two groups receiving masks of entonox and oxygen, respectively. Quantitative measurement of pain was performed by visual analog scale, before the intervention, after 3, 5, 10, and 30 min of that. If the pain was not relieved after 30 min, 50 μg fentanyl was infused. If the pain was still continued, ketorolac and ketamine were used. Hospitalization duration and severity of pain at specified times were compared between patients in two groups.Results:The mean (standard deviation) time of hospitalization was 211 (59) and 236 (61) min in fentanyl + entonox and fentanyl + O2 groups, respectively (P = 0.024). The decrease in pain severity after 10 and 30 min in fentanyl + entonox group were significantly greater than fentanyl + O2 group (P = 0.002 and 0.001, respectively). Mean (standard error) of needed time for renal colic pain to get better was 11.27 (1.23) and 20.47 (1.71) min in fentanyl + entonox and fentanyl + O2 groups, respectively (P < 0.001). Proportion of patients relief from pain in fentanyl + entonox in the second, third, and fourth measurements were significantly more than fentanyl + O2 group (P = 0.036, P < 0.001, and P < 0.001, respectively).Conclusion:Entonox is more effective to decrease the duration of hospitalization and reduction of pain than O2 in renal colic patients.

Intravenous acetaminophen versus morphine sulfate in pain management of acute renal colic: a randomized clinical trial

Objective: The main purpose in the treatment of renal colic patients in emergency department is pain management. This study aimed to compare the analgesic effects of intravenous (IV) acetaminophen and morphine sulfate in this regard. Methods: This double blind clinical trial was conducted on >18 years old renal colic patients in need of pain management in emergency department. Pain severity was recorded as 15, 30, and 60 minutes before injection, and 120 minutes after injection. In addition, side effects were compared between IV acetaminophen and morphine sulfate groups using SPSS version 16. Results: A total of 355 patients were randomly allocated to one of the treatment groups. There were no significant differences between the two groups regarding baseline characteristic of participants. There was no significant difference in the pain intensity of the groups; 15 (P = 0.13) and 30 (P = 0.15) minutes after treatment. Although, the difference in pain severity was statistically significant between the two groups; 60 (P = 0.02) and 120 (P = 0.003) minutes after the infusion. This was not clinically important. The prevalence of side effects in morphine group was higher than the acetaminophen group (RR: 2.14, 95% CI: 1.53-2.98, P< 0.0001). Conclusion: Based on the findings, IV morphine sulfate and acetaminophen had equal effectiveness regarding acute renal colic pain management, but considering the significantly higher frequency of side effects, IV acetaminophen seems to be a more reasonable choice in this regard.

19 Collaborative Application of Guidelines Changes Imaging Utilization and Impacts Length of Stay in Acute Renal Colic

Applying guidelines to the management of acute renal colic in the emergency department (ED) provides an opportunity to improve resource utilization and clinical care for this patient population. We engaged in a collaborative effort across specialties within our academic institution to influence practice patterns in the ED through the formation of diagnostic and treatment algorithms that incorporated guidelines from multiple specialty societies and Choosing Wisely statements. We sought to investigate the changes in imaging utilization and ED length of stay (LOS) before and after the employment of these efforts. We conducted a before and after study following introduction of a renal colic order set and evaluation algorithm (Figure 1). A retrospective chart review was completed of patients diagnosed with nephrolithiasis in the ED at a single academic institution. Two reviewers were utilized to identify renal colic patients by searching final ED diagnosis. Individual patient encounters were subsequently analyzed for rates of imaging utilization and ED LOS. The pre-intervention and post-intervention cohorts included 456 and 174 patients respectively. The utilization of imaging and ED LOS are summarized in Table 1. There was a statistically significant decrease from 57% to 44% in CT utilization after the intervention. The average ED LOS for patients receiving bedside ultrasound was 199 minutes (95% CI 182 to 216 minutes), while average ED LOS for patients receiving CT imaging was 336 minutes (95% CI 316 to 356 minutes). Overall ED LOS for the pre-intervention cohort was 291 minutes (95% CI 277 to 305 minutes), while overall ED LOS for the post-intervention cohort was 269 minutes (95% CI 250 to 288 minutes). Our collaborative educational initiative and employment of evidence-based algorithms impacted imaging utilization in our ED patients with nephrolithiasis. The CT utilization rate was reduced in a statistically significant manner. Patients who had bedside US performed had a significantly decreased LOS, as compared with those receiving CT. The average overall ED LOS was lower in the post-protocol group, though this reduction did not reach statistical significance. Further study will involve the evaluation of impacts in clinical outcomes, as well as predictive factors for downstream urological intervention.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

A retrospective analysis of nebulized versus intravenous fentanyl for renal colic

Study objectiveTo assess the effectiveness of nebulized fentanyl used for analgesia in renal colic. Materials/methodsThis research was planned as a randomized, blinded study in which prospectively collected data were analyzed retrospectively to compare nebulized and intravenous (iv) fentanyl therapies. Patients with renal colic with ‘moderate’ or worse pain on a four-point verbal pain score (VPS) or with pain of 20mm or above on a 100-mm visual analogue score (VAS) at time of presentation were randomized into iv fentanyl (n=62) or nebulized fentanyl (n=53) study groups. Decreases in VAS and VPS scores at 15 and 30min compared to baseline, rescue analgesia requirements and side-effects between the groups were compared. ResultsBoth iv fentanyl and nebulized fentanyl provided effective analgesia in renal colic patients at the end of 30min. However, iv fentanyl provided more rapid and more effective analgesia than nebulized fentanyl. Patients receiving iv fentanyl had lower rescue analgesia requirements than those receiving nebulized fentanyl (37.1% vs 54.7%), although the difference was not statistically significant (p=0.058). In addition, side-effects were more common in the iv fentanyl group compared to the nebulized fentanyl group (22.1% vs 9.4%), although the difference was also not significant (p=0.058). ConclusionNebulized fentanyl provides effective analgesia in patients with renal colic. However, iv fentanyl exhibits more rapid and more powerful analgesic effects than nebulized fentanyl. Nonetheless, due to its ease of use and few potential risks and side-effects the nebulized form can be used as an alternative in renal colic.

Role of point-of-care ultrasound in renal colic patients without hydronephrosis to decrease the length of stay in HGH-ED

Introduction: Renal colic is one of the common abdominal emergency presentations to an ED. The cost of imaging, health care resources and time spent in the Emergency Department (ED) is huge. There is good evidence supporting the role of ED bedside ultrasound in detecting hydronephrosis.1,2 We plan to study the role of bedside ultrasound in renal colic as a pilot audit for the QIP. Method: A convenience sample was selected prospectively. In all patients, a bedside ultrasound was performed by emergency ultrasound fellow, focused to answer presence or absence of hydronephrosis was performed. The results of ultrasound were recorded using online Google docs. A CT-KUB scan was performed for all these patients as per departmental guidelines. The results of CT and USG finding, disposition, and timings for the registration, to perform USG, and to get CT reports were recorded and analyzed. Results: A total of 24 patients aged between 18 and 65 years were included in the study. The average length of stay (LOS) in ED was 15.1 hours (3.7–60.3 hours). The mean time to perform bedside USG was 4.0 ± 2.4 hour. The average time to get the CT-KUB results was 6.0 ± 2.4 hours. The negative predicative value of bedside USG was 80%. None of the patients without hydronephrosis had obstructing stone or required admission. In patients without hydronephrosis, the average LOS of ED stay, in disposition based on CT results, was 2.08 hours higher than the disposition bedside USG results. Conclusion: These observations are limited as part of small audit data. However, it could be future direction to explore, the role of bedside USG performed by ED physicians, in renal colic to decrease the ED LOS.

Imaging of flank pain: readdressing state-of-the-art.

Pain resulting from renal and ureteral stones is a common cause for patients presenting in the acute setting. Since the late 1990s, computed tomography (CT) has been the initial imaging method of choice to evaluate patients with suspected ureteral stones; however, concerns regarding both radiation dose and cost-effectiveness have prompted investigations into a different imaging algorithm. Studies utilizing ultrasound have provided evidence indicating that it may be a more appropriate first step, with selective use of CT in selected cases, in the diagnostic work-up. Techniques have evolved with low-dose CT, dual-energy CT, and magnetic resonance urography emerging as useful in imaging of renal colic patients. This manuscript reviews the current literature on state-of-the-art imaging for acute flank pain and proposes a new imaging algorithm in the evaluation of patients with acute flank pain and suspected ureteral stones.

LO047: Predictors of treatment failure in renal colic patients discharged from the emergency department

Introduction: Most patients with acute renal colic are discharged from the ED after initial diagnosis and symptom control, but 20-30% require repeat ED visits for ongoing pain, and 15-25% require rescue intervention (ureteroscopic intervention or lithotripsy). If patients destined for failure of outpatient management could be identified based on information available during their ED visits, they could be prioritized early for intervention to reduce short term pain and disability. Our objective was to identify predictors of outpatient treatment failure, defined as the need for hospitalization or rescue intervention within 60 days of ED discharge. Methods: We collated prospectively gathered administrative data from all Calgary region patients with an ED diagnosis of renal colic over a one-year period. Demographics, arrival mode, triage category, vital signs, pain scores, analgesic use and ED disposition were recorded. Research assistants reviewed imaging reports and documented stone characteristics. These data were linked with regional hospital databases to identify ED revisits, hospital admissions, and surgical procedures. The primary outcome was hospitalization or rescue intervention within 60 days of ED discharge. Results: Of 3104 patients with first ED visit for acute renal colic, 1296 had CT or US imaging and were discharged without intervention. Median age was 50 years and 69% were male. 325 patients (25.1%) required an ED re-visit and 11.8% required admission or rescue intervention. Patients with small (&lt;5mm), medium (5-7mm) and large (&gt;7mm) stones failed in 9.0%, 14.4% and 9.9% of cases respectively. The only factor predictive of treatment failure in multivariable models was stone position in the proximal or mid-ureter. Age, sex, vital signs, pain score, WBC, creatinine, history of prior stone or intervention, stone side, stone size, presence of stranding and degree of hydronephrosis were not associated with outpatient failure. Conclusion: Outpatient treatment failure could not be predicted based on any of the predictors studied.

LO060: Diagnostic and prognostic value of hydronephrosis in emergency department patients with acute renal colic

Introduction: Hydronephrosis is a marker of stone-related ureteral obstruction. Our objective was to assess the diagnostic and prognostic value of hydronephrosis in ED patients with renal colic. Methods: We used an administrative database to identify all renal colic patients seen in Calgary’s four EDs in 2014. Research assistants reviewed imaging reports to identify proven ureteral stones, and to document hydronephrosis and stone size. Surgical interventions, ED and hospital visits within 60-days were collated from all regional hospitals. The primary outcome was sensitivity and specificity of hydronephrosis (moderate or severe) for detecting stones &gt;5mm. We also assessed the association of hydronephrosis with index admission-intervention, and with outcomes at 7 and 60 days. Results: In 2014, 1828 patients had a confirmed ureteral stone plus assessment of hydronephrosis and stone size (1714 CT, 114 US). Hydronephrosis was absent, mild, moderate or severe in 15%, 47%, 34% and 4% of patients respectively. Median stone size was 4.0, 4.0, 5.0 and 7.0mm for patients in these categories. Mild, moderate and severe hydronephrosis were highly associated with admission (OR=2.0, 4.6, 9.8; p&lt;0.001) and index visit surgical intervention (OR=2.1, 3.7, 6.0; p&lt;0.001). The presence of moderate-severe hydronephrosis was 54.7% sensitive and 65.4% specific for stones &gt; 5mm, with positive and negative predictive values of 51% and 74.2%. Of 1828 patients, 748 had an index visit surgical procedure and 1080 were discharged with medical management. In the latter group, hydronephrosis was absent, mild, moderate or severe in 20%, 50%, 27% and 3%. Corresponding median (IQR) stone size was 3.0, 4.0, 4.0 and 5.0mm. Of 1080 medically managed patients, 19% and 25% had an unscheduled ED revisit by 14 and 60 days, 9% and 10% were hospitalized by 7 and 60 days, and 13% had a rescue procedure within 60 days. In the medically managed group, degree of hydronephrosis had no statistical association with any outcomes at 7 or 60 days. Conclusion: Hydronephrosis has poor sensitivity, specificity and predictive value for stones &gt;5mm. Degree of hydronephrosis is highly associated with MD decisions for admission and intervention, but not associated with patient outcomes in the absence of these decisions. Despite poor diagnostic and prognostic performance, hydronephrosis is likely guiding critical early management decisions.

MP51-01 SIXTY-DAY OUTCOMES AFTER SURGICAL VS. MEDICAL TREATMENT OF ACUTE RENAL COLIC

You have accessJournal of UrologyStone Disease: Surgical Therapy V1 Apr 2016MP51-01 SIXTY-DAY OUTCOMES AFTER SURGICAL VS. MEDICAL TREATMENT OF ACUTE RENAL COLIC Taylor Remondini, Samir Sami, Bryce Weber, Dean Wong, Anthony Cook, and Grant Innes Taylor RemondiniTaylor Remondini More articles by this author , Samir SamiSamir Sami More articles by this author , Bryce WeberBryce Weber More articles by this author , Dean WongDean Wong More articles by this author , Anthony CookAnthony Cook More articles by this author , and Grant InnesGrant Innes More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.456AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Renal colic is a common condition, affecting up to 10% of the population. Recent research suggests that medical expulsive therapy may be less effective in successful passage rates. Therefore we wish to evaluate a large cohort of renal colic patients in a high intervention setting to determine their characteristics and health care burden. METHODS This multicenter administrative database study retrospectively reviewed the all Calgary patients with an ED diagnosis of renal colic between Jan 1, 2014 and Dec 31, 2014. Demographics were captured from the regional ED database, tests and treatments from the order entry database, and ED revisits, admissions and interventions from the discharge abstract database. RESULTS 3104 renal colic visits were studied at 4 hospitals, including 921 (30%) with an index surgical intervention and 2183 (70%) managed medically. 1850 (54%) had confirmed ureteric stones and of these 752 (41%) had surgery at index visit with an additional 137 (8%) having surgery with in 60 days. Patients were more likely to have surgery if had a proximal ureteric stone (P<0.001, OR 2.2), stone larger than 5 mm (P<0.001, OR 4.4), or hydronephrosis (p<0.001, OR 2.3). Within 60 days surgical patients had higher need for readmission (p<0.001, OR 2.2) and emergency visits (p<0.001, OR 1.8). The presence of a proximal stone at index visit was the main risk factor for surgical patients requiring further ED visits, and readmission (p<0.001, OR 1.2). Medically managed patients had a trend toward more surgical procedures (p=0.06, OR 0.74) in the following sixty days and the main risk factor being the presence of a proximal stone (p<0.001, OR 2.9) at index visit. CONCLUSIONS Patients who undergo early surgical intervention for acute renal colic have more hospital visits and less surgical procedures in the following 60-days than medically treated patients; however, outcome differences are driven by stone location. Stone size and the presence of hydronephrosis were deciding factors in need for surgery yet did not lead to more ED visits, admissions or procedures post index visit. Yet proximal stones not only were more likely to have index surgery but also had more ED visits, and admissions post initial procedure. Similarly if a proximal stone is managed medically it is also more likely to require a procedure with in 60 days possibly just delaying the issues with surgery in this cohort. © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e681 Advertisement Copyright & Permissions© 2016MetricsAuthor Information Taylor Remondini More articles by this author Samir Sami More articles by this author Bryce Weber More articles by this author Dean Wong More articles by this author Anthony Cook More articles by this author Grant Innes More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Application of Ureteroscope in Emergency Treatment with Persistent Renal Colic Patients during Pregnancy.

BackgroundAlthough the application of ureteroscopy in the treatment of ureteral calculi during pregnancy has been on the rise, for persistent renal colic patients without ultrasound-detected ureteral calculi, it may represent a clinical dilemma due to the potential risks for both mother and fetus.ObjectiveThe aim of the present study is to present our experience with the application of the ureteroscope in the emergency treatment of persistent renal colic patients during pregnancy.MethodsFrom March 2009 to September 2014, a total of 117 pregnant women who received ureteroscopy for persistent renal colic were retrospectively analyzed. Patients were divided into three groups according to duration of the persistent renal colic: Group A (within 12 hours; 24 cases); Group B (12 to 24 hours; 76 cases); and Group C (more than 24 hours; 17 cases). The stone-free rate, complications, and other qualitative data were analyzed.ResultsOf the 117 patients, 31 patients who were found not to have renal or ureteral calculi received ureteroscopic double-J (DJ) stent insertion, whereas 86 patients who were found with ureteral calculi received ureteroscopic lithotripsy (URSL) and DJ stent insertion. Among them, 24 patients (27.9%) were found with ureteral calculi by ureteroscopy rather than ultrasound. In addition, 73 patients (84.9%) had complete fragmentation of calculi; 12 patients (10.3%) had a threatened abortion (the rates of threatened abortion in Groups A, B and C were 8.3% vs. 6.5% vs. 29.4%; Group C compared with Groups A and B, p<0.05), and one patient (1.2%) had urosepsis (in Group C). However, these complications were cured with conservative treatment, without postpartum infant and maternal complications.ConclusionFor pregnant patients with persistent renal colic/ureteral calculi and hydronephrosis, ureteroscopic DJ stent insertion and URSL are effective and safe options when conservative treatment fails, even if no urinary calculi were found by ultrasound. At the same time, for patients with persistent renal colic during pregnancy, early application of ureteroscopy may reduce the risk of preterm birth.

Ureteral Stent Insertion in the Management of Renal Colic during Pregnancy.

To determine an optimal invasive intervention for renal colic patients during pregnancy after conservative treatments have been found to be unhelpful. Among the available invasive interventions, we investigated the reliability of a ureteral stent insertion, which is considered the least invasive intervention during pregnancy. Between June 2006 and February 2015, a total of 826 pregnant patients came to the emergency room or urology outpatient department, and 39 of these patients had renal colic. The mean patient age was 30.49 years. In this retrospective cohort study, the charts of the patients were reviewed to collect data that included age, symptoms, the lateralities and locations of urolithiasis, trimester, pain following treatment and pregnancy complications. Based on ultrasonography diagnoses, 13 patients had urolithiasis, and 13 patients had hydronephrosis without definite echogenicity of the ureteral calculi. Conservative treatments were successful in 25 patients. Among these treatments, antibiotics were used in 15 patients, and the remaining patients received only hydration and analgesics without antibiotics. Several urological interventions were required in 14 patients. The most common intervention was ureteral stent insertion, which was performed in 13 patients to treat hydronephrosis or urolithiasis. The patients' pain was relieved following these interventions. Only one patient received percutaneous nephrostomy due to pyonephrosis. No pregnancy complications were noted. Ureteral stent insertion is regarded as a reliable and stable first-line urological intervention for pregnant patients with renal colic following conservative treatments. Ureteral stent insertion has been found to be equally effective and safe as percutaneous nephrostomy, which is associated with complications that include bleeding and dislocation, and the inconvenience of using external drainage system.